Clinical presentation of a missed primary aorto-enteric fistula.

JPMA. The Journal of the Pakistan Medical Association

PubMedID: 18173048

Mehmood RK, Mushtaq A, Andrew DR, Miller GA. Clinical presentation of a missed primary aorto-enteric fistula. J Pak Med Assoc. 2007;57(12):616-8.
Primary aortoenteric fistula is a rare but potentially fatal cause of gastrointestinal bleeding. The diagnosis of primary aortoeteric fistula is difficult to make and is usually accompanied by a very high level of clinical suspicion. In the context of a known abdominal aortic aneurysm it is reasonable to have a high index of clinical suspicion ofaortoenteric fistula. It should be included in the differential diagnosis with low back pain and a palpable midline abdominal mass in a haemodynamically stable patient. We present a case of a 59 year old man with no past history of abdominal aortic aneurysm presented with lower back and periumblical pain. Initial misdiagnosis led to a delay in treatment and the patient succumbed to the illness.